Provider Demographics
NPI:1447268099
Name:WILSON, LINDA CAROL (LISW)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:CAROL
Last Name:WILSON
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1020 TRUMP RD NW
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:OH
Mailing Address - Zip Code:44615-8422
Mailing Address - Country:US
Mailing Address - Phone:330-627-7055
Mailing Address - Fax:330-627-7602
Practice Address - Street 1:1020 TRUMP RD NW
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:OH
Practice Address - Zip Code:44615-8422
Practice Address - Country:US
Practice Address - Phone:330-627-7055
Practice Address - Fax:330-627-7602
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-03
Last Update Date:2023-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI-00041471041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHWISW17142Medicare ID - Type Unspecified